An implantable seizure monitor can include at least one sensing electrode and an electronics module configured to detect, record and/or log neurological events. For example, the electronics module can be configured to detect brainwaves indicative of seizures, such as, for example, epileptic seizures, and to create a log indicating when such seizures occur. The implantable seizure monitor can include a cushioning member made of a soft material and configured to be implantable between the epidermis and cranium of a patient.
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1. An implantable recording device for detecting and logging neurological events comprising:
a sensor configured to generate an electrical signal indicative of neurological activity;
an electronic module coupled to the sensor configured to detect and log neurological events in response to the generated electrical signal;
a housing enclosing the electronic module and partially enclosing the sensor leaving a portion of the sensor exposed to receive neurological activity; and
a cushioning member including a top portion and a bottom portion and partially surrounding the housing therebetween, the top portion holding the housing spaced apart from and above the bottom portion, the cushioning member adapted to be oriented with the bottom portion adjacent the cranium of a human patient so that when the implantable recording device is implanted, the housing is spaced apart from the cranium and the exposed portion of the sensor's exposed portion is not covered by the housing or the cushioning member to sense the neurological activity.
2. The implantable recording device of
3. The implantable recording device of
4. The implantable recording device of
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This application is a divisional application of U.S. patent application Ser. No. 12/770,643, entitled “Implantable Seizure Monitor” filed Apr. 29, 2010, which is a continuation application of U.S. patent application Ser. No. 11/371,701, entitled “Implantable Seizure Monitor” filed Mar. 8, 2006, now issued as U.S. Pat. No. 7,787,945, issued Aug. 31, 2010, which are incorporated by reference herein in their entirety.
1. Field of the Inventions
The inventions disclosed herein are directed to devices for detecting brainwaves, and more particularly, devices for detecting and logging neurological events indicative of seizures.
2. Description of the Related Art
Epilepsy, a neurological disorder characterized by the occurrence of seizures (specifically episodic impairment or loss of consciousness, abnormal motor phenomena, psychic or sensory disturbances, or the perturbation of the autonomic nervous system), is debilitating to a great number of people. It is believed that as many as two to four million Americans may suffer from various forms of epilepsy. Research has found that its prevalence may be even greater worldwide, particularly in less economically developed nations, suggesting that the worldwide figures for epilepsy sufferers may be in excess of one hundred million.
Because epilepsy is characterized by seizures, its sufferers are frequently limited in the kinds of activities they may participate in. Epilepsy can prevent people from driving, working, or otherwise participating in much of what society has to offer. Some epilepsy sufferers have serious seizures so frequently that they are effectively incapacitated.
Furthermore, epilepsy is often progressive and can be associated with degenerative disorders and conditions. Over time, epileptic seizures often become more frequent and more serious, and in particularly severe cases, are likely to lead to deterioration of other brain functions (including cognitive function) as well as physical impairments.
The current state of the art in treating neurological disorders, particularly epilepsy, typically involves drug therapy and surgery. The first approach is usually drug therapy.
A number of drugs are approved and available for treating epilepsy, such as sodium valproate, phenobarbital/primidone, ethosuximide, gabapentin, phenytoin, and carbamazepine, as well as a number of others. Unfortunately, those drugs typically have serious side effects, especially toxicity, and it is extremely important in most cases to maintain a precise therapeutic serum level to avoid breakthrough seizures (if the dosage is too low) or toxic effects (if the dosage is too high). The need for patient discipline is high, especially when a patient's drug regimen causes unpleasant side effects the patient may wish to avoid.
Moreover, while many patients respond well to drug therapy alone, a significant number (at least 20-30%) do not. For those patients, surgery is presently the best-established and most viable alternative course of treatment.
Currently practiced surgical approaches include radical surgical resection such as hemispherectomy, corticectomy, lobectomy and partial lobectomy, and less-radical lesionectomy, transection, and stereotactic ablation. Besides being less than fully successful, these surgical approaches generally have a high risk of complications, and can often result in damage to eloquent (i.e., functionally important) brain regions and the consequent long-term impairment of various cognitive and other neurological functions. Furthermore, for a variety of reasons, such surgical treatments are contraindicated in a substantial number of patients. And unfortunately, even after radical brain surgery, many epilepsy patients are still not seizure-free.
Electrical stimulation is an emerging therapy for treating epilepsy. However, currently approved and available electrical stimulation devices apply continuous electrical stimulation to neural tissue surrounding or near implanted electrodes, and do not perform any detection—they are not responsive to relevant neurological conditions.
The NeuroCybernetic Prosthesis (NCP) from Cyberonics, for example, applies continuous electrical stimulation to the patient's vagus nerve. This approach has been found to reduce seizures by about 50% in about 50% of patients. Unfortunately, a much greater reduction in the incidence of seizures is needed to provide clinical benefit. Medtronic presently offers several DBS systems, including the Activa, Solectra, and Kinetra systems. The Activa system includes a pectorally implanted continuous deep brain stimulator intended primarily to treat Parkinson's disease. In operation, it supplies a continuous electrical pulse stream to a selected deep brain structure where an electrode has been implanted.
Continuous stimulation of deep brain structures for the treatment of epilepsy has not met with consistent success. To be effective in terminating seizures, it is believed that one effective site where stimulation should be performed is near the focus of the epileptogenic region. The focus is often in the neocortex, where continuous stimulation may cause significant neurological deficit with clinical symptoms including loss of speech, sensory disorders, or involuntary motion. Accordingly, research has been directed toward automatic responsive epilepsy treatment based on a detection of imminent seizure.
A typical epilepsy patient experiences episodic attacks or seizures, which are generally electrographically defined as periods of abnormal neurological activity. As is traditional in the art, such periods shall be referred to herein as “ictal”.
Most prior work on the detection and responsive treatment of seizures via electrical stimulation has focused on analysis of electroencephalogram (EEG) and electrocorticogram (ECoG) waveforms. In general, EEG signals represent aggregate neuronal activity potentials detectable via electrodes applied to a patient's scalp. ECoG signals, deep-brain counterparts to EEG signals, are detectable via electrodes implanted on or under the dura mater, and usually within the patient's brain. Unless the context clearly and expressly indicates otherwise, the term “EEG” shall be used generically herein to refer to both EEG and ECoG signals.
Much of the work on detection has focused on the use of time-domain analysis of EEG signals. See, e.g., J. Gotman, Automatic seizure detection: improvements and evaluation, Electroencephalogr. Clin. Neurophysiol. 1990; 76(4): 317-24. In a typical time-domain detection system, EEG signals are received by one or more implanted electrodes and then processed by a control module, which then is capable of performing an action (intervention, warning, recording, etc.) when an abnormal event is detected.
It is generally preferable to be able to detect and treat a seizure at or near its beginning, or even before it begins. The beginning of a seizure is referred to herein as an “onset.” However, it is important to note that there are two general varieties of seizure onsets. A “clinical onset” represents the beginning of a seizure as manifested through observable clinical symptoms, such as involuntary muscle movements or neurophysiological effects such as lack of responsiveness. An “electrographic onset” refers to the beginning of detectable electrographic activity indicative of a seizure. An electrographic onset will frequently occur before the corresponding clinical onset, enabling intervention before the patient suffers symptoms, but that is not always the case. In addition, there are changes in the EEG that occur seconds or even minutes before the electrographic onset that can be identified and used to facilitate intervention before electrographic or clinical onsets occur. This capability would be considered seizure prediction, in contrast to the detection of a seizure or its onset.
In the Gotman system, EEG waveforms are filtered and decomposed into “features” representing characteristics of interest in the waveforms. One such feature is characterized by the regular occurrence (i.e., density) of half-waves exceeding a threshold amplitude occurring in a specified frequency band between approximately 3 Hz and 20 Hz, especially in comparison to background (non-ictal) activity. When such half-waves are detected, it is believed that seizure activity is occurring For related approaches, see also H. Qu and J. Gotman, A seizure warning system for long term epilepsy monitoring, Neurology 1995; 45: 2250-4; and H. Qu and J. Gotman, A Patient-Specific Algorithm for the Detection of Seizure Onset in Long-Term EEG Monitoring: Possible Use as a Warning Device, IEEE Trans. Biomed. Eng. 1997; 44(2): 115-22.
The Gotman articles address half wave characteristics in general, and introduce a variety of measurement criteria, including a ratio of current epoch amplitude to background; average current epoch EEG frequency; average background EEG frequency; coefficient of variation of wave duration; ratio of current epoch amplitude to following time period; average wave amplitude; average wave duration; dominant frequency (peak frequency of the dominant peak); and average power in a main energy zone. These criteria are variously mapped into an n-dimensional space, and whether a seizure is detected depends on the vector distance between the parameters of a measured segment of EEG and a seizure template in that space.
It should be noted that the schemes set forth in the above articles are not tailored for use in an implantable device, and hence typically require more computational ability than would be available in such a device.
U.S. Pat. No. 6,018,682 to Rise describes an implantable seizure warning system that implements a form of the Gotman system. However, the system described therein uses only a single detection modality, namely a count of sharp spike and wave patterns within a timer period. This is accomplished with relatively complex processing, including averaging over time and quantifying sharpness by way of a second derivative of the signal. The Rise patent does not disclose how the signals are processed at a low level, nor does it explain detection criteria in any sufficiently specific level of detail.
A more computationally demanding approach is to transform EEG signals into the frequency domain for rigorous spectrum analysis. See, e.g., U.S. Pat. No. 5,995,868 to Dorfineister et al., which analyzes the power spectral density of EEG signals in comparison to background characteristics. Although this approach is generally believed to achieve good results, for the most part, its computational expense renders it less than optimal for use in long-term implanted epilepsy monitor and treatment devices. With current technology, the battery life in an implantable device computationally capable of performing the Dorfineister method would be too short for it to be feasible.
Also representing an alternative and more complex approach is U.S. Pat. No. 5,857,978 to Hively et al., in which various non-linear and statistical characteristics of EEG signals are analyzed to identify the onset of ictal activity. Once more, the calculation of statistically relevant characteristics is not believed to be feasible in an implantable device.
U.S. Pat. No. 6,016,449 to Fischell, et al. (which is hereby incorporated by reference as though set forth in full herein), describes an implantable seizure detection and treatment system. In the Fischell et al. system, various detection methods are possible, all of which essentially rely upon the analysis (either in the time domain or the frequency domain) of processed EEG signals. Fischell's controller is preferably implanted intracranially, but other approaches are also possible, including the use of an external controller. When a seizure is detected, the Fischell system applies responsive electrical stimulation to terminate the seizure, a capability that will be discussed in further detail below.
All of these approaches provide useful information, and in some cases may provide sufficient information for accurate detection and prediction of most imminent epileptic seizures.
However, none of the various implementations of the known approaches provide 100% seizure detection accuracy in a clinical environment.
Two types of detection errors are generally possible. A “false positive,” as the term is used herein, refers to a detection of a seizure or ictal activity when no seizure or other abnormal event is actually occurring. Similarly, a “false negative” herein refers to the failure to detect a seizure or ictal activity that actually is occurring or shortly will occur.
In most cases, with all known implementations of the known approaches for detecting abnormal seizure activity solely by monitoring and analyzing EEG activity, when a seizure detection algorithm is tuned to catch all seizures, there will be a significant number of false positives. While it is currently believed that there are minimal or no side effects to limited amounts of over-stimulation (e.g., providing stimulation sufficient to terminate a seizure in response to a false positive), the possibility of accidentally initiating a seizure or increasing the patient's susceptibility to seizures must be considered.
As is well known, it has been suggested that it is possible to treat and terminate seizures by applying electrical stimulation to the brain. See, e.g., U.S. Pat. No. 6,016,449 to Fischell et al., and H. R. Wagner, et al., Suppression of cortical epileptiform activity by generalized and localized ECoG desynchronization, Electroencephalogr. Clin. Neurophysiol. 1975; 39(5): 499-506. And as stated above, it is believed to be beneficial to perform this stimulation only when a seizure (or other undesired neurological event) is occurring or about to occur, as inappropriate stimulation may result in the initiation of seizures.
Furthermore, it should be noted that a false negative (that is, a seizure that occurs without any warning or treatment from the device) will often cause the patient significant discomfort and detriment. Clearly, false negatives are to be avoided.
It has been found to be difficult to achieve an acceptably low level of false positives and false negatives with the level of computational ability available in an implantable device with reasonable battery life.
Preferably, the battery in an implantable device, particularly one implanted intracranially, should last at least several years. There is a substantial risk of complications (such as infection, blood clots, and the overgrowth of scar tissue) and lead failure each time an implanted device or its battery is replaced.
As stated above, the detection and prediction of ictal activity has traditionally required a significant amount of computational ability. Moreover, for an implanted device to have significant real-world utility, it is also advantageous to include a number of other features and capabilities. Specifically, treatment (via electrical stimulation or drug infusion) and/or warning (via an audio annunciator, for example), recording of EEG signals for later consideration and analysis, and telemetry providing a link to external equipment are all useful capabilities for an implanted device capable of detecting or predicting epileptiform signals. All of these additional subsystems will consume further power.
Moreover, size is also a consideration. For various reasons, intracranial implants are favored. A device implanted intracranially (or under the scalp) will typically have a lower risk of failure than a similar device implanted pectorally or elsewhere, which require a lead to be run from the device, through the patient's neck to the electrode implantation sites in the patient's head. This lead is also prone to receive additional electromagnetic interference.
As is well known in the art, the computational ability of a processor-controlled system is directly related to both size and power consumption. In accordance with the above considerations, therefore, it would be advantageous to have sufficient detection and prediction capabilities to avoid a substantial number of false positive and false negative detections, and yet consume little enough power (in conjunction with the other subsystems) to enable long battery life. Such an implantable device would have a relatively low-power central processing unit to reduce the electrical power consumed by that portion.
More recently, as described in U.S. Pat. No. 6,810,285, issued to Pless et al., implantable devices have been developed which provide both detection/prediction of ictal activity and electrostimulation for attenuating or stopping an epileptic seizure. These devices are implanted firstly by performing a craniotomy in which a portion of the skull is cut away and then mounting the device in the empty space left after the craniotomy. Electrodes that are connected to the implant device are implanted onto the surface of or into the brain lobes at a depth of up to about 1 to 2 cm. These electrodes are used for the detection of ictal activity as well as the delivery of electrostimulation.
In order to identify the preferred implantation sites for the electrodes, it is advantageous to record a patient's brainwaves, and more particularly, brainwaves indicative of ictal activity, to identify the area from which the ictal brainwaves originate. Further, it is advantageous to identify the frequency of a patient's ictal activity in order to optimize the device that is eventually implanted into the patient's brain matter.
One persistent hurdle that remains in the precise diagnosis and understanding of a particular patient's form of epilepsy is the patient's memory regarding his or her own seizure activity. For example, an epileptic patient can have seizures while they are awake, yet completely forget the seizure ever occurred. Further, epileptic patients can also have seizures during sleep, and thus, never have an opportunity to form a memory of the seizure.
An aspect of at least one of the embodiments disclosed herein includes the realization that the diagnosis and the adaptation of a treatment for an epileptic patient can be enhanced by providing a patient with an implantable seizure monitor that is, for example, configured to detect and/or record brainwaves indicative of ictal activity.
In some embodiments, the device can be implanted between the epidermis and the skull. As such, a craniotomy is not required to implant the device, thus reducing the complexity of the implantation procedure and reducing the risks of surgery. Further, the patient can have the benefit of objective and reliable recording and/or logging of ictal events without the need for external wire leads which may be inconvenient or embarrassing for a patient.
In some embodiments, the device can include a processor and a power supply mounted within a housing and a cushioning material in which the housing is suspended. Sensors for detecting brainwaves can be suspended in the cushioning material and connected to the housing with leads. As such, the device can be comfortably implanted between the epidermis and the cranium. Additionally, this arrangement allows the sensors to be spaced apart to provide better directional detection of the ictal brainwaves and allows the size of the housing to be reduced.
Thus, in accordance with an aspect of at least one of the embodiments disclosed herein, an implantable recording device for detecting and logging neurological events is provided. The recording device can include a housing enclosing at least one electronic module and at least a first sensing electrode connected to the electronic module. Additionally, the recording device can comprise a cushioning member surrounding at least three sides of each of the housing and the at least one sensing electrode, the cushioning member being made from a soft biocompatible material.
In accordance with an aspect of at least another of the embodiments disclosed herein, a method of monitoring a seizure disorder of an animal is provided. The method can include implanting a seizure monitor between the epidermis and cranium of the animal, wherein the seizure monitor can include a housing enclosing an electronic module configured to detect and log seizure events, at least first and second sensing electrodes, and the cushioning member surrounding at least three sides of each of the housing and the sensing electrodes.
In accordance with an aspect of at least a further embodiment, an implantable device for detecting neurological events can be provided. The device can comprise at least one sensor configured to detect brainwaves and to generate a signal indicative of the brainwaves. An amplifier can be configured to amplify signal from the sensor. Additionally, an event detector can be configured to determine if a neurological event has occurred based on the saturation of the amplifier.
These and other objects, features, and advantages of the inventions will become apparent from the detailed description below and the accompanying drawings, in which:
The inventions described herein, with reference to detailed illustrative and exemplary embodiments, are described in the context of an implant disposed between the epidermis and skull of a human patient. However, the inventions disclosed herein can be used in other context as well. It is apparent from the description provided below that the systems, apparatuses, and methods can be embodied in a wide variety of forms. Consequently, the specific structural and functional details disclosed herein are only representative and do not limit the scope of the inventions.
In some embodiments, the implantable recording device 110 is configured to be capable of detecting or predicting any kind of neurological event that has a representative electrographic signature. While the disclosed embodiment is described primarily as responsive to epileptic seizures, it should be recognized that it is also possible to respond to other types of neurological disorders, such as movement disorders (e.g. the tremors characterizing Parkinson's disease), migraine headaches, chronic pain, and neuropsychiatric disorders such as depression. Preferably, neurological events representing any or all of these afflictions can be detected when they are actually occurring, in an onset stage, or as a predictive precursor before clinical symptoms begin.
In the disclosed embodiment, the recording device 110 is implanted between a patient's epidermis and skull, for example, as schematically illustrated in
The device 110 is preferably configured to generally follow or to be sufficiently deformable so as to follow the contours of a patient's cranium 214. However, other locations are also possible. For example, the device 110 can be configured to be implanted pectorally (not shown) with leads extending through the patient's neck and between the patient's cranium and epidermis.
It should be recognized that the embodiment of the device 110 described and illustrated herein is preferably a recording device for detecting seizures or their onsets or precursors, and recording or logging these events. For example, the device 110 can be configured to begin recording all or some of the detected EEG signals from the patient at the onset or as a result of a prediction of ictal activity and to continue recording until the ictal activity stops, and optionally, to save such a recording, or a sampling of it, to a memory device for later downloading. Alternatively, or in addition, the device 110 can be configured to create a log of such events.
For example, but without limitation, the device 110 can be configured to record or log the date and time when each such event begins and ends, the duration of the event, indications of the intensity of the event, etc. The device 110 can also be configured, optionally, to download such a log to external equipment, described in greater detail below.
With continued reference to
The device 110 can also include a cushioning member 228 configured to provide a comfortable cushion for the patient. For example, the cushioning member 228 can be comprised of silicone rubber or other types of biocompatible material that can provide a comfortable cushion for a device that is implanted between the epidermis and the cranium 214.
In some embodiments, the housing 226 is suspended completely within the cushioning member 228 such that no portion of the outer surface of the housing 226 is exposed to the outer surface of the cushioning member 228. In other embodiments, the housing 226 can be partially suspended within the cushioning member 228 such that one or more surfaces of the housing 226 are exposed to the outer surface of the cushioning member 228.
In some embodiments, the sensor 222 is exposed to an outer surface of the cushioning member 228 so as to allow the sensor 222 to receive neurological signals from the patient with as little attenuation as possible.
To implant the device 110, firstly, an implantation site is chosen. Because the device 110 can be made quite small, it may be possible to find a cranial contour having a somewhat recessed shape that is also in an acceptable place on the cranium that would serve as an appropriate location for recording ictal brainwaves. A small linear incision can be made at this location with a length that is at least slightly larger than the width of the device. A surgical instrument can be used to elevate the epidermis to form a pocket. In some embodiments, the device 110 can be disposed below the dermis, the subcutaneous tissue, or the galea.
For example, as shown in
With the epidermis, and/or dermis, and/or subcutaneous tissue, and/or the galea, elevated with a surgical instrument, the device 110 can then be pushed into the space and thus form a pocket around the device 110. For this procedure, local anesthesia can be used and the entire procedure can be completed on the order of 15 minutes. As such, the surgical risks can be reduced.
In some variations, before the device 110 is inserted below the epidermis, dermis, subcutaneous tissue, or galea, an additional recess can be drilled into the cranium 214. For example, a small recess (not shown) can be drilled into the cranium 214 for receiving this sensor 222. As such, the sensor 222 can receive neurological signals with less attenuation because there would be less bone between the sensor 222 and the brain tissue that generates the electrographic activity that is detected. Therefore, the signals would be larger in amplitude which would allow clearer reception for the sensor that would make the detection process easier. And in other alternatives, the craniotomy can be performed where the bone would be completely removed to allow even clearer reception for the sensors 412.
With continued reference to
In other alternatives, the housing 226 can be implanted in an appropriate location of the cranium 214 and a separate lead can be used to connect the electronics within the housing 226 with a sensor 222 implanted in a seizure onset location that is more remote from the location of the housing.
The housing 226 can be fabricated from a biocompatible material. For example, but without limitation, Titanium, which is light, extremely strong, and biocompatible, can be used to form the housing 226.
The housing 226 can enclose a battery and any electronic circuitry, described below in greater detail, to provide the functionality described herein, as well as any other features. As is described in further detail below, a telemetry coil (not shown) can be provided inside or outside of the housing 226 (and potentially integrated with a lead wire connecting the sensor 222 to the housing 226) to facilitate communication between the device 110 and external devices.
The implantable recording device 110 configuration described herein and illustrated in
As noted above, and as illustrated in
In the disclosed embodiment, the wireless link 310 can be established by moving a wand (or other apparatus) having communication capabilities and coupled to the programmer 312 into range of the device 110. The programmer 312 can then be used to manually control the operation of the device 110, as well as to transmit information to or receive information from the device 110. Several specific capabilities and operations performed by the programmer 312 in conjunction with the device are described in further detail below.
The programmer 312 can be configured to perform a number of advantageous operations. For example, the programmer 312 can be configured to specify and set variable parameters in the device 110 to adapt the function of the device 110 to meet the patient's needs, download or receive data (including but not limited to stored EEG waveforms, parameters, or logs of events detected) from the device 110 to the programmer 312, upload or transmit program code and other information from the programmer 312 to the device 110, or command the device 110 to perform specific actions or change modes as desired by a physician operating the programmer 312. To facilitate these functions, the programmer 312 is adapted to receive physician input 314 and provide physician output 316; data is transmitted between the programmer 312 and the device 110 over the wireless link 310.
The programmer 312 can be coupled via a communication link 318 to a network 320 such as the Internet. This allows any information downloaded from the device 110, as well as any program code or other information to be uploaded to the device 110, to be stored in a database at one or more data repository locations (which may include various servers and network-connected programmers like the programmer 312). This would allow a patient (and the patient's physician) to have access to important data, including past treatment information and software updates, essentially anywhere in the world that there is a programmer (like the programmer 312) and a network connection.
The device 110 can also have a sensor (not shown) configured to detect a magnetic field. For example, such a sensor can be configured to be triggered by a magnet moved into the vicinity of the device 110 by the patient or caregiver when the patient was experiencing clinical symptoms of a seizure or other significant neurological event. The device 110 can additionally be configured to then store an electrocorticogram sample that would be indicative of the seizure or neurological event. These magnet triggered electrocorticograms could then be analyzed to program the detection parameters.
An overall block diagram of the device 110 used for measurement, detection, and/or recording is illustrated in
The connection between the leads connecting the electrodes 412, 414, to the control module 410 can be accomplished through a lead connector (not shown). Although two electrodes are shown in
The electrodes 412, 414 can be connected to an electrode interface 420. Preferably, the electrode interface is capable of selecting each electrode as required for sensing; accordingly the electrode interface is coupled to a detection subsystem 422. The electrode interface can also provide any other features, capabilities, or aspects, including but not limited to amplification, isolation, and charge-balancing functions, that can be used for a proper interface with neurological tissue and not provided by any other subsystem of the device 110.
The detection subsystem 422 can include an EEG analyzer function. The EEG analyzer function can be adapted to receive EEG signals from the electrodes 412, 414, through the electrode interface 420, and to process those EEG signals to identify neurological activity indicative of a seizure, an onset of a seizure, or a precursor to a seizure.
One way to implement such EEG analysis functionality is disclosed in detail in U.S. Pat. No. 6,016,449 to Fischell et al., incorporated by reference above, and additional methods are described in detail below. The detection subsystem can optionally also contain further sensing and detection capabilities, including but not limited to parameters derived from other physiological conditions (such as electrophysiological parameters, temperature, blood pressure, etc.).
The control module 410 can also include a memory subsystem 426 and a central processing unit (CPU) 428, which can take the form of a microcontroller. The memory subsystem can be coupled to the detection subsystem 422 (e.g., for receiving and storing data representative of sensed EEG signals and evoked responses) and the CPU 428, which can control the operation of the memory subsystem 426. In addition to the memory subsystem 426, the CPU 428 can also be connected to the detection subsystem 422 for direct control thereof.
The control module 410 can also include a communication subsystem 430 which can be coupled to the memory subsystem 426 and the CPU 428. The communication subsystem 430 can be configured to enable communication between the device 110 (
The control module 410 can include other subsystems. For example, the control module 410 can include a power supply 432 and a clock supply 434. The power supply 432 can be configured to supply the voltages and currents desired for each of the other subsystems. The clock supply 434 can be configured to supply substantially all of the other subsystems with any clock and/or timing signals desired for their operation.
It should be noted that while the memory subsystem 426 is illustrated in
Rounding out the subsystems in the control module 410 are a power supply 432 and a clock supply 434. The power supply 432 supplies the voltages and currents necessary for each of the other subsystems. The clock supply 434 supplies substantially all of the other subsystems with any clock and timing signals necessary for their operation.
Signals received from the electrodes 412, 414 (as routed through the electrode interface 420) are received in an electrode selector 510. The electrode selector 510 allows the device to select which electrodes should be routed to which individual sensing channels of the detection subsystem 422, based on commands received through a control interface 518 from the memory subsystem 426 or the CPU 428 (
Preferably, each sensing channel of the detection subsystem 422 receives a bipolar signal representative of the difference in electrical potential between two selectable electrodes. Accordingly, the electrode selector 510 provides signals corresponding to each pair of selected electrodes to a sensing front end 512, which performs amplification, analog to digital conversion, and multiplexing functions on the signals in the sensing channels. The sensing front end is described further below in connection with
A multiplexed input signal representative of all active sensing channels can then be fed from the sensing front end 512 to a waveform analyzer 514. The waveform analyzer 514 is preferably a special-purpose digital signal processor (DSP) adapted for use with the embodiment, or in an alternative embodiment, can comprise a programmable general-purpose DSP.
In some embodiments, the waveform analyzer can have its own scratchpad memory area 516 used for local storage of data and program variables when signal processing is being performed. In either case, the signal processor performs suitable measurement and detection methods described generally above and in greater detail below. Any results from such methods, as well as any digitized signals intended for storage transmission to external equipment, are passed to various other subsystems of the control module 410, including the memory subsystem 426 and the CPU 428 (
With reference to
In some embodiments, each of the differential amplifier channels 610 is adapted to receive or to share inputs with one or more other differential amplifier channels 610 without adversely affecting the sensing and detection capabilities of a system according to some embodiments. For clarity, only one channel is illustrated in
Each differential amplifier channel 610 feeds a corresponding analog to digital converter (ADC) 612. Preferably, the analog to digital converters 612 are separately programmable with respect to sample rates—in the disclosed embodiment, the ADCs 612 convert analog signals into 10-bit unsigned integer digital data streams at a sample rate selectable between 250 Hz and 500 Hz.
In several of the illustrations described below where waveforms are shown, sample rates of 250 Hz are typically used for simplicity. However, the inventions disclosed herein shall not be deemed to be so limited, and numerous sample rate and resolution options are possible, with tradeoffs known to individuals of ordinary skill in the art of electronic signal processing. The resulting digital signals are received by a multiplexer 614 that creates a single interleaved digital data stream representative of the data from all active sensing channels. As described in further detail below, not all of the sensing channels need to be used at one time, and it may in fact be advantageous in certain circumstances to deactivate certain sensing channels to reduce the power consumed by a system according to some embodiments.
It should be noted that as illustrated and described herein, a “sensing channel” is not necessarily a single physical or functional item that can be identified in any illustration. Rather, a sensing channel can be formed from the functional sequence of operations described herein, and particularly represents a single electrical signal received from any pair or combination of electrodes, as preprocessed by a system according to some embodiments, in both analog and digital forms. See, e.g., U.S. patent application Ser. No. 09/517,797 to D. Fischell et al., filed on Mar. 2, 2000 and entitled “Neurological Event Detection Using Processed Display Channel Based Algorithms and Devices Incorporating These Procedures,” which is hereby incorporated by reference as though set forth in full herein. At times (particularly after the multiplexer 614), multiple sensing channels are processed by the same physical and functional components of the system; notwithstanding that, it should be recognized that unless the description herein indicates to the contrary, a system according to some embodiments processes, handles, and treats each sensing channel independently.
The interleaved digital data stream is passed from the multiplexer 614, out of the sensing front end 512, and into the waveform analyzer 514. The waveform analyzer 514 is illustrated in detail in
The interleaved digital data stream representing information from all of the active sensing channels is first received by a channel controller 710. The channel controller applies information from the active sensing channels to a number of wave morphology analysis units 712 and window analysis units 714. It is preferred to have as many wave morphology analysis units 712 and window analysis units 714 as possible, consistent with the goals of efficiency, size, and low power consumption necessary for an implantable device. In some embodiments, there are sixteen wave morphology analysis units 712 and eight window analysis units 714, each of which can receive data from any of the sensing channels of the sensing front end 512, and each of which can be operated with different and independent parameters, including differing sample rates, as will be discussed in further detail below.
Further, in some embodiments, such as embodiments using only a single bipole channel, the wave form analyzer 514 can operate with as little as one or two wave morphology analysis units 712 and one or two window analysis units 714, each of which can receive data from the single channel of the sensing front end 512, each of which can be operated with different and independent parameters, including different sampling rates. Reducing the number of wave morphology analysis units 712 and window analysis units 714 allows the recording device 110 to be further reduced in size.
Each of the wave morphology analysis units 712 can operate to extract certain feature information from an input waveform as described below in conjunction with
A “detection channel,” as the term is used herein, refers to a data stream including the active sensing front end 512 and the analysis units of the waveform analyzer 514 processing that data stream, in both analog and digital forms. It should be noted that each detection channel can receive data from a single sensing channel; each sensing channel preferably can be applied to the input of any combination of detection channels. The latter selection is accomplished by the channel controller 710. As with the sensing channels, not all detection channels need to be active; certain detection channels can be deactivated to save power or if additional detection processing is deemed unnecessary in certain applications.
In conjunction with the operation of the wave morphology analysis units 712 and the window analysis units 714, a scratchpad memory area 516 can be provided for temporary storage of processed data. The scratchpad memory area 516 can be physically part of the memory subsystem 426, or alternatively may be provided for the exclusive use of the waveform analyzer 514. Other subsystems and components of a system according to an embodiment can also be furnished with local scratchpad memory, if such a configuration is desired.
An exemplary but non-limiting operation of the event detector logic 716 is illustrated in detail in the functional block diagram of
A first sensing channel 810 provides input to a first event detector 812. While the first event detector 812 is illustrated as a functional block in the block diagram of
Considering the processing performed by the event detectors 812, 816, and 822, the first input channel 810 feeds a signal to both a wave morphology analysis unit 824 (one of the wave morphology analysis units 712 of
Outputs from the wave morphology analysis unit 824, the line length analysis tool 828, and the area analysis tool 830 can be combined in a Boolean AND operation 832 and sent to an output 834 for further use by a system according to an embodiment. For example, if a combination of analysis tools in an event detector identifies several simultaneous (or near-simultaneous) types of activity in an input channel, a system according to an embodiment can be programmed to perform an action in response thereto. Exemplary details of the analysis tools and the combination processes that can be used in the event detectors are described in greater detail below.
In the second event detector 816, only a wave morphology analysis unit 836 is active. Accordingly, no Boolean operation needs to be performed, and the wave morphology analysis unit 836 directly feeds an event detector output 838.
The third event detector 822 can operate on two input channels 818 and 820, and can include two separate detection channels of analysis units: a first wave morphology analysis unit 840 and a first window analysis unit 842, the latter including a first line length analysis tool 844 and a first area analysis tool 846; and a second wave morphology analysis unit 848 and a second window analysis unit 850, the latter including a second line length analysis tool 852 and a second area analysis tool 854. The two detection channels of analysis units can be combined to provide a single event detector output 856.
In the first detection channel of analysis units 840 and 842, outputs from the first wave morphology analysis unit 840, the first line length analysis tool 844, and the first area analysis tool 846 can be combined via a Boolean AND operation 858 into a first detection channel output 860. Similarly, in the second detection channel of analysis units 848 and 850, outputs from the second wave morphology analysis unit 848, the second line length analysis tool 852, and the second area analysis tool 854 can be combined via a Boolean AND operation 862 into a second detection channel output 864. In the illustrated embodiment, the second detection channel output 864 is invertible with selectable Boolean logic inversion 866 before it is combined with the first detection channel output 860. Subsequently, the first detection channel output 860 and the second detection channel output 864 are combined with a Boolean AND operation 868 to provide a signal to the output 856. In an alternative embodiment, a Boolean OR operation is used to combine the first detection channel output 860 and the second detection channel output 864.
In some embodiments, the second detection channel (analysis units 848 and 850) represents a “qualifying channel” with respect to the first detection channel (analysis units 840 and 842). In general, a qualifying channel allows a detection to be made only when both channels are in concurrence with regard to detection of an event. For example, a qualifying channel can be used to indicate when a seizure has “generalized,” i.e. spread through a significant portion of a patient's brain. To do this, the third input channel 818 and the fourth input channel 820 can be configured to receive EEG waveforms from separate amplifier channels coupled to electrodes in separate parts of the patient's brain (e.g., in opposite hemispheres). Accordingly, then, the Boolean AND operation 868 will indicate a detection only when the first detection output 860 and the second detection output 864 both indicate the presence of an event (or, when Boolean logic inversion 866 is present, when the first detection output 860 indicates the presence of an event while the second detection output 864 does not). As described in further detail below, the detection outputs 860 and 864 can be provided with selectable persistence (i.e., the ability to remain triggered for some time after the event is detected), allowing the Boolean AND combination 868 to be satisfied even when there is not precise temporal synchronization between detections on the two channels.
It should be appreciated that the concept of a “qualifying channel” allows the flexible configuration of a device 110 to achieve a number of advantageous results. In addition to the detection of generalization, as described above, a qualifying channel can be configured, for example, to detect noise so a detection output is valid only when noise is not present, to assist in device configuration in determining which of two sets of detection parameters is preferable (by setting up the different parameters in the first detection channel and the second detection channel, then replacing the Boolean AND combination with a Boolean OR combination), or to require a specific temporal sequence of detections (which would be achieved in software by the CPU 428 after a Boolean OR combination of detections). There are numerous other possibilities.
The outputs 834, 838, and 856 of the event detectors are preferably represented by Boolean flags, and as described below, provide information for the operation of a system according to an embodiment.
While
The second waveform 912 represents a filtered version of the original EEG waveform 910. As shown, most of the high-frequency energy has been eliminated from the signal, and the waveform 912 is significantly smoother. In the disclosed embodiment, this filtering operation is performed in the sensing front end 512 before the analog to digital converters 612 (
The filtered waveform 912 can then be sampled by one of the analog to digital converters 612; this operation is represented graphically in the third waveform 914 of
Referring now to
In a first half wave 1012, which is partially illustrated in
A second half wave 1018 extends between the first local extremum 1016 and a second local extremum 1020. Again, a second perturbation 1022 is of insufficient amplitude to be considered an extremum. Likewise, a third half wave 1024 extends between the second local extremum 1020 and a third local extremum 1026; this may appear to be a small perturbation, but is greater in amplitude than a selected hysteresis threshold. The remaining half waves 1028, 1030, 1032, 1034, and 1036 are identified analogously. As will be discussed in further detail below, each of the identified half waves 1012, 1018, 1024, 1028, 1030, 1032, 1034, and 1036 has a corresponding duration 1038, 1040, 1042, 1044, 1046, 1048, 1050, and 1052, respectively, and analogously, a corresponding amplitude determined from the relative positions of each half wave's starting point and ending point along the vertical axis, and a slope direction, increasing or decreasing.
In a method performed according to some embodiments, it is particularly advantageous to allow for a programmable hysteresis setting in identifying the ends of half waves. In other words, as explained above, the end of an increasing or decreasing half wave might be prematurely identified as a result of quantization (and other) noise, low-amplitude signal components, and other perturbing factors, unless a small hysteresis allowance is made before a reversal of waveform direction (and a corresponding half wave end) is identified. Hysteresis allows for insignificant variations in signal level inconsistent with the signal's overall movement to be ignored without the need for extensive further signal processing such as filtering. Without hysteresis, such small and insignificant variations might lead to substantial and gross changes in where half waves are identified, leading to unpredictable results.
The processing steps performed with regard to the waveform 1010 and half waves of
If the current EEG sample has an amplitude less than the ending threshold (step 1122), then the hysteresis value has been exceeded, and a local extremum has been identified. Accordingly, the end of the increasing half wave has been reached, and the amplitude and duration of the half wave are calculated (step 1124). The amplitude is equal to the peak amplitude minus the first sample value; the duration is equal to the current half wave duration. Otherwise, the next ample is awaited (step 1114).
If both the amplitude and the duration qualify by exceeding corresponding preset thresholds (step 1126), then the amplitude, duration, half wave time, half wave direction (increasing) are stored in a buffer (step 1128), and the half wave time is reset to zero (step 1130).
At the conclusion of the increasing half wave, the process continues by initializing wave duration, the ending threshold, the peak amplitude, and the first sample value (step 1132). Wave duration is set to zero, the ending threshold is set to the last sample value plus the hysteresis value, the peak amplitude and the first sample value are set to the most recent sample value.
After waiting for a measurement of the current EEG sample (step 1134), the half wave time and half wave duration variables are incremented (step 1136). If the current EEG sample has an amplitude lower than the peak amplitude (step 1138), then the amplitude of the half wave is decreasing (or continues to decrease). Accordingly, the ending threshold is reset to be the current EEG sample's amplitude plus the hysteresis value, the peak is reset to the current EEG sample's amplitude (step 1140), and the next sample is awaited (step 1134).
If the current EEG sample has an amplitude greater than the ending threshold (step 1142), then the hysteresis value has been exceeded, and a local extremum has been identified. Accordingly, the end of the decreasing half wave has been reached, and the amplitude and duration of the half wave are calculated (step 1144). The amplitude is equal to the first sample value minus the peak amplitude, and the duration is equal to the current half wave duration. Otherwise, the next EEG sample is awaited (step 1134).
If both the amplitude and the duration qualify by exceeding corresponding preset thresholds (step 1146), then the amplitude, duration, half wave time, half wave direction (decreasing) are stored in a buffer (step 1148), and the half wave time is reset to zero (step 1150). It should be noted that, in the context of this specification, the term “exceed” in regard to a threshold value means to meet a specified criterion. Generally, to exceed a threshold herein is to have a numeric value greater than or equal to the threshold, although other interpretations (such as greater than, or less than, or less than or equal to, depending on the context) may be applicable and are deemed to be within the scope of the present inventions.
At the conclusion of the decreasing half wave, further half waves are then identified by repeating the process from step 1112. As half wave detection is an ongoing and continuous process, this procedure preferably does not exit, but may be suspended from time to time when conditions or device state call for it, e.g. when the device is inactive. Once suspended, the procedure should recommence with the first initialization step 1110.
Accordingly, the process depicted in
This stored information is used in the software process illustrated in
Each time the software process of
Logic inversion allows the output flag for the wave morphology analysis unit (or any other analyzer) to be selectively inverted. If logic inversion is configured to be applied to an output of a particular analysis unit, then the corresponding flag will be clear when the detection criterion (e.g., number of qualified half waves) is met, and set when the detection criterion is not met. This capability provides some additional flexibility in configuration, facilitating detection of the absence of certain signal characteristics when, for example, the presence of those characteristics is the norm.
In some embodiments, the half wave window flag (set in step 1220) indicates whether a sufficient number of qualified half waves occur over an interval ending in the most recent processing window. To reduce the occurrence of spurious detections, an X of Y criterion is applied, causing the wave morphology analysis unit to trigger only if a sufficient number of qualified half waves occur in X of the Y most recent processing windows, where X and Y are parameters individually adjustable for each analysis tool. This process is illustrated in
Initially, a sum (representing recent processing windows having the half wave window flag set) is cleared to zero and a current window pointer is initialized to point to the most recent processing window (step 1310). If the half wave window flag corresponding to the current window pointer is set (step 1312), then the sum is incremented (step 1314). If there are more processing windows to examine (for an X of Y criterion, a total of Y processing windows, including the most recent, should be considered) (step 1316), then the window pointer is decremented (step 1318) and the flag testing and sum incrementing steps (steps 1312-1314) are repeated.
After Y windows have been considered, if the sum of windows having set half wave window flags meets the threshold X (step 1320), then the half wave analysis flag is set (step 1322), persistence (described below) is applied (step 1324), and the procedure is complete. Otherwise, the half wave analysis flag is cleared (step 1326).
Persistence, another per-analysis-tool setting, allows the effect of an event detection (a flag set) to persist beyond the end of the detection window in which the event occurs. In some embodiments, persistence can be set anywhere from one second to fifteen seconds (though other settings are possible), so if detections with multiple analysis tools do not all occur simultaneously (though they should still occur within a fairly short time period), a Boolean combination of flags will still yield positive results. Persistence can also be used with a single analysis tool to smooth the results.
When the process of
The total line length for the window 1412 is the sum of the sample-to-sample amplitude differences within that window 1412. For example, the first contribution to the line length within the window 1412 is a first amplitude difference 1414 between a previous sample 1416 occurring immediately before the window 1412 and a first sample 1418 occurring within the window 1412. The next contribution comes from a second amplitude difference 1420 between the first sample 1418 and a second sample 1422; a further contribution 1424 comes from a third amplitude difference between the second sample 1422 and a third sample 1426; and so on. At the end of the window 1412, the final contribution to the line length comes from a last amplitude difference 1430 between a second-last sample 1432 in the window 1412 and a last sample 1434 in the window 1412. Note that all line lengths, whether increasing or decreasing in direction, are accumulated as positive values; accordingly, a decreasing amplitude difference 1414 and an increasing amplitude difference 1428 both contribute to a greater line length.
As illustrated herein, and as discussed in detail above, there are thirty-two samples within the window 1412. The illustrated window 1412 has a duration of 128 ms, and accordingly, the illustrated sample rate is 250 Hz. It should be noted, however, that alternate window durations and sample rates are possible and considered to be appropriate for some embodiments.
The line lengths illustrated in
In various alternative embodiments, either the measured difference (as calculated in step 1514, described above), or the sample values used to calculate the difference can be mathematically transformed in useful nonlinear ways. For example, it may be advantageous in certain circumstances to calculate the difference between adjacent samples using the squares of the sample values, or to calculate the square of the difference between sample values, or both. It is contemplated that other transformations (such as square root, exponentiation, logarithm, and other nonlinear functions) might also be advantageous in certain circumstances. Whether or not to perform such a transformation and the nature of any transformation to be performed are preferably programmable parameters of the device 110.
For use in the next iteration, the previous sample is replaced with the value of the current sample (step 1516), and the calculated absolute value is added to the total (step 1518). If there are more samples remaining in the window 1412 (step 1520), another current sample is awaited (step 1512) and the process continues. Otherwise, the line length calculation for the window 1412 is complete, and the total is stored (step 1522), the total is re-initialized to zero (step 1510), and the process continues.
As with the half wave analysis method set forth above, the line length calculation does not need to terminate; it can be free-running yet interruptible. If the line length calculation is restarted after having been suspended, it should be re-initialized and restarted at the beginning of a window. This synchronization can be accomplished through hardware interrupts.
The line lengths calculated as shown in
The process begins by calculating a running accumulated line length total over a period of n time windows. Where n>1, the effect is that of a sliding window; in an alternative embodiment an actual sliding window processing methodology may be used. First, the accumulated total is initialized to zero (step 1610). A current window pointer is set to indicate the nth-last window, i.e., the window (n−1) windows before the most recent window (step 1612). The line length of the current window is added to the total (step 1614), the current window pointer is incremented (step 1616), and if there are more windows between the current window pointer and the most recent (last) window (step 1618), the adding and incrementing steps (1614-1616) are repeated. Accordingly, by this process, the resulting total includes the line lengths for each of the n most recent windows.
In some embodiments, the accumulated total line length is compared to a dynamic threshold, which is based on a trend of recently observed line lengths. The trend is recalculated regularly and periodically, after each recurring line length trend interval (which is preferably a fixed or programmed time interval). Each time the line length trend interval passes (step 1620), the line length trend is calculated or updated (step 1622). In some embodiments, this is accomplished by calculating a normalized moving average of several trend samples, each of which represents several consecutive windows of line lengths. A new trend sample is taken and the moving average is recalculated upon every line length trend interval. The number of trend samples used in the normalized moving average and the number of consecutive windows of line length measurements per trend sample are preferably both fixed or programmable values.
After the line length trend has been calculated, the line length threshold is calculated (step 1624) based on the new line length trend. In some embodiments, the threshold can be set as either a percentage of the line length trend (either below 100% for a threshold that is lower than the trend, or above 100% for a threshold that is higher than the trend) or alternatively a fixed numeric offset from the line length trend (either negative for a threshold that is lower than the trend, or positive for a threshold that is higher than the trend). Other methods for deriving a numeric threshold from a numeric trend can also be used in accordance with some embodiments.
The first time the process of
If the accumulated line length total exceeds the calculated threshold (step 1626), then a flag is set (step 1628) indicating a line-length-based event detection on the current window analysis unit channel 714. As described above, in some embodiments, the threshold is dynamically calculated from a line length trend, but alternatively, the threshold may be static, either fixed or programmed into the device 110. If the accumulated line length total does not exceed the threshold, the flag is cleared (step 1630). Once the line length flag has been either set or cleared, logic inversion is applied (step 1632), persistence is applied (step 1634), and the procedure terminates.
The resulting persistent line length flag indicates whether the threshold has been exceeded within one or more windows over a time period corresponding to the line length flag persistence. As discussed in further detail below, line length event detections can be combined with the half wave event detections, as well as any other applicable detection criteria according to some embodiments.
The total area under the curve represented by a waveform 1710 within the window 1712 is equal to the sum of the absolute values of the areas of each rectangular region of unit width vertically bounded by the horizontal axis and the sample. For example, the first contribution to the area under the curve within the window 1712 comes from a first region 1714 between a first sample 1716 and a baseline 1717. A second contribution to the area under the curve within the window 1712 comes from a second region 1718, including areas between a second sample 1720 and the baseline 1717. There are similar regions and contributions for a third sample 1722 and the baseline 1717, a fourth sample 1724 and the baseline 1717, and so on. It should be observed that the region widths are not important—the area under each sample can be considered the product of the sample's amplitude and a unit width, which can be disregarded. In a similar manner, each region is accumulated and added to the total area under the curve within the window 1712. Although the concept of separate rectangular regions is a useful construct for visualizing the idea of area under a curve, it should be noted that a process for calculating area need not partition areas into regions as shown in FIG. 17—it is only necessary to accumulate the absolute value of the waveform's amplitude at each sample, as the unit width of each region can be disregarded. The process for doing this will be set forth in detail below in connection with
The areas under the curve illustrated in
As with the line length calculation method described above (with reference to
The calculated absolute value is added to the total (step 1816). If there are more samples remaining in the window 1712 (step 1818), another current sample is awaited (step 1812) and the process continues. Otherwise, the area calculation for the window 1712 is complete, and the total is stored (step 1820), the total is reinitialized to zero (step 1810), and the process continues.
As with the half wave and line length analysis methods set forth above, the area calculation does not need to terminate; it can be free-running yet interruptible. If the area calculation is restarted after having been suspended, it should be re-initialized and restarted at the beginning of a window. This synchronization can be accomplished through hardware interrupts.
The line lengths calculated as shown in
The process begins by calculating a running accumulated area total over a period of n time windows. Where n>1, the effect is that of a sliding window; in an alternative embodiment an actual sliding window processing methodology may be used. First, the accumulated total is initialized to zero (step 1910). A current window pointer is set to indicate the nth-last window, i.e., the window (n−1) windows before the most recent window (step 1912). The area for the current window is added to the total (step 1914), the current window pointer is incremented (step 1916), and if there are more windows between the current window and the most recent (last) window (step 1918), the adding and incrementing steps (1914-1916) are repeated. Accordingly, by this process, the resulting total includes the areas under the curve for each of the n most recent windows.
In some embodiments, the accumulated total area can be compared to a dynamic threshold, which can be based on a trend of recently observed areas. The trend can be recalculated regularly and periodically, after each recurring area trend interval (which is preferably a fixed or programmed time interval). Each time the area trend interval passes (step 1920), the area trend can be calculated or updated (step 1922). In some embodiments, this can be accomplished by calculating a normalized moving average of several trend samples, each of which represents several consecutive windows of areas. A new trend sample can be taken and the moving average is recalculated upon every area trend interval. The number of trend samples used in the normalized moving average and the number of consecutive windows of area measurements per trend sample are preferably both fixed or programmable values.
After the area trend has been calculated, the area threshold can be calculated (step 1924) based on the new area trend. As with line length, discussed above, the threshold can be set as either a percentage of the area trend (either below 100% for a threshold that is lower than the trend, or above 100% for a threshold that is higher than the trend) or alternatively a fixed numeric offset from the area trend (either negative for a threshold that is lower than the trend, or positive for a threshold that is higher than the trend).
The first time the process of
If the accumulated total exceeds the calculated threshold (step 1926), then a flag is set (step 1928) indicating an area-based event detection on the current window analysis unit channel 714. Otherwise, the flag is cleared (step 1930). Once the area flag has been either set or cleared, logic inversion is applied (step 1932), persistence is applied (step 1934), and the procedure terminates.
The resulting persistent area flag indicates whether the threshold has been exceeded within one or more windows over a time period corresponding to the area flag persistence. As discussed in further detail below, area event detections can be combined with the half wave event detections, line length event detections, as well as any other applicable detection criteria according to some embodiments.
In some embodiments, each threshold for each channel and each analysis tool can be programmed separately; accordingly, a large number of individual thresholds can be used. It should be noted thresholds can vary widely; they can be updated by a physician via the external programmer 312 (
With regard to the flow charts of
In some embodiments, one of the detection schemes set forth above (e.g., half wave detection) can be adapted to use an X of Y criterion to weed out spurious detections. This can be implemented via a shift register, as usual, or by more efficient computational methods. As described above, half waves are analyzed on a window-by-window basis, and as described above (in connection with
Also, in the disclosed embodiment, each detection flag, after being set, remains set for a selected amount of time, allowing them to be combined by Boolean logic (as described below) without necessarily being simultaneous.
As indicated above, each of the software processes set forth above (
The process begins with the receipt of a timer interrupt (step 2010), which is typically generated on a regular periodic basis to indicate the edges of successive time windows. Accordingly, in a system or method in some embodiments, such a timer interrupt is received every 128 ms, or as otherwise programmed or designed. Then the half wave (step 2012,
Flags, indicating whether particular signal characteristics have been identified in each active channel, for each active analysis tools, can then be combined into detection channels (step 2018) as illustrated in
The flags for multiple detection channels are then combined into event detector flags (step 2020), which are indicative of identified neurological events calling for action by the device. This process is described below, see
If an event detector flag is set (step 2022), then a corresponding action is initiated (step 2024) by the device. Actions according to some embodiments can include the presentation of a warning to the patient, an initiation of a device mode change, or a recording of certain EEG signals or other data; it will be appreciated that there are numerous other possibilities. It is preferred, but not necessary, for actions initiated by a device according to some embodiments to be performed in parallel with the sensing and detection operations described in detail herein.
Multiple event detector flags are possible, each one representing a different combination of detection channel flags. If there are further event detector flags to consider (step 2026), those event detector flags can also be evaluated (step 2022) and may cause further actions by the device (step 2024). It should be noted that, in general, actions performed by the device (as in step 2024) may be in part dependent on a device state—even if certain combinations of events do occur, no action may be taken if the device is in an inactive state, for example.
As described above, and as illustrated in
If the corresponding analysis tool flag is set (step 2114), the output detection channel flag remains set, and further analysis tools for the same channel, if any (step 2118), are evaluated. Accordingly, this combination procedure operates as a Boolean AND operation—if any of the enabled and active analysis tools for a particular detection channel does not have a set output flag, then no detection channel flag is output by the procedure.
A clear analysis tool flag indicates that no detection has been made within the flag persistence period, and for those analysis tools that employ an X of Y criterion, that such criterion has not been met. In certain circumstances, it may be advantageous to also provide detection channel flags with logic inversion. Where a desired criterion (i.e., combination of analysis tools) is not met, the output flag is set (rather than cleared, which is the default action). This can be accomplished by providing selectable Boolean logic inversion (step 2120) corresponding to each event detector.
Also as described above, and as illustrated in
With reference again to
In some embodiments, such data can be saved in the memory 516, or any other memory device included in the device 110, in the form of tabulated data, or in any other form. An exemplary data table 2300 is illustrated in
Below these data fields is a chart indicating the number of seizures identified by the implantable recording device 110. This chart is labeled “seizure counts”. The vertical axis of this graph indicates the number of seizures counted. The horizontal axis can serve as a timeline. In this case, the days on which seizures were counted are identified as Day W, Day X, Day Y, and Day Z. On the days identified as W, X, and Z, one seizure was counted on each day. On the day labeled Day Y, two seizures were counted.
Below the seizure count chart are samples of brainwave recordings that can be captured by the implantable recording device 110. Each of these recordings are identified corresponding to the day and time at which they were recorded.
As noted above, the seizure report of
Such tabulated data can include an indication of the type of flag that has been set, such as, for example, but without limitation, the area flag of step 1928, the set line length flag of step 1628, and the halfway flag of step 1322, and/or other flags.
As shown in
Similarly, the routine of
Additionally, the routine of
In some embodiments, the routine of
In some embodiments, the routine of
As shown in
The electrode spacing 2406 should be adequate to sense partial seizures that are only occurring in a limited region of the brain. An example would be a unilateral temporal lobe seizure that does not spread beyond the temporal lobe of onset. Thus, in some embodiments, a spacing 2406 of at least about 3 centimeters as illustrated in
The device 110′ also includes a cushion member 228′ in which the housing 226 and the sensing electrodes 412, 414, are suspended. In some embodiments, the cushioning member 228′ can be a soft silicone rubber material. However, any type of soft biocompatible material can be used as the cushioning member 228′.
As shown in
Preferably, the housing 226 is suspended within the cushioning member 228′ such that no portion of the outer surface of the housing 226 is exposed through the outer surfaces 2408, 2410, 2412, 2414, 2416, 2418 of the cushioning member 228′. This helps provide the patient with enhanced comfort by preventing the hard, and in some embodiments Titanium, outer portions of the housing 226 from contacting the inner layers of the patient's scalp and/or cranium 214 (
On the other hand, preferably, at least the lower surfaces of the sensing electrodes 412, 414 are exposed through the bottom surface 2410 of the cushioning member 228′. As such, an exposed outer surface of the sensing electrodes 412, 414, can come into direct contact with the inner layers of the patient's scalp, the patient's cranium 214, and/or the patient's dura, which enhances the ability of the sensing electrodes 412, 414 to receive EEG signals.
In the illustrated arrangement of the recording device 110′, the sensing electrodes 412, 414 are substantially held in place by the cushioning member 228′. The illustrated configuration of the cushioning member 228′ is generally the shape of a pair of wings extending from the housing 226, each of the wings supporting one of the sensing electrodes 412, 414.
Additionally, as shown in
In an exemplary but nonlimiting embodiment, with the illustrated configuration, the longitudinal length 2420 of the housing 226 can be about 1.5 centimeters. The overall width 2422 of the recording device 110′ can be about 1.5 centimeters. Additionally, the sensing electrodes 412, 414, can have a diameter of about 0.4 centimeters. Finally, the overall thickness 2424 (
As shown in
The mounting tabs 2430 can have any configuration. In some embodiments, the mounting tabs 2430 project from an upper surface of the housing 226″ and include an aperture on a portion of the mounting tabs 2430 that extends outwardly from and outer edge of the housing 226″. The mounting tabs 2430 thus can be configured to provide additional anchoring points for securing the recording device 110″ to the skull 214 of a patient.
In some embodiments, the mounting tabs 2430 can extend outwardly from the cushioning number 228″. In some embodiments, the mounting tabs 2430 can be completely encased in the cushioning member 228″. In some embodiments, the top, front, and rear faces of the housing 226 can be left exposed without any of the cushioning member to 228″ covering those faces. In such embodiments, it can be more desirable to leave the bottom face of the housing to 226″ covered with the cushioning member 228″. However, this is optional.
The recording device 110″ is placed within the installation site 2440 such that the mounting tabs 2430 extend over an outer surface of the cranium 214. In this position, screws can be inserted through the apertures defined in the mounting tabs 2430 and into the cranium 214. As such, the recording device 110″ can be better secured in place and maintained within the installation site 2440.
Additionally, because of the inclusion of the cushioning member 228″, the recording device 110″ better conforms to the arching configuration of the installation site 2440, and more are particularly, the outer surface of the cortex. Thus, the recording device 110″ can be more comfortable for the patient.
After a recording device, such as the recording devices 110, 110′, 110″, have been implanted in a patient, the amplifiers 610 within such recording devices can be adjusted. For example,
However, when devices such as on of the recording devices 110, 110′, 110″ is first installed, the maximum amplitudes of voltages detected by the sensors 412, 414 cannot be predicted. Thus, after the initial installation of such a device, amplifier adjustments can be made so that the voltages output from the amplifier 610 are within a normal operation range for the amplifier 610, and such that the voltage output from the amplifier 610 does not reach the maximum output voltage of the amplifier 610 an excessive number of times.
For example,
In
However, if the amplifier 610 reaches its saturation point and thus outputs maximum or minimum voltages more than about once per second during normal brainwave activity, then the gain of the amplifier 610 may be too high. Thus, the gain of the amplifier 610 can be reduced until the signal output from the amplifier 610 reaches its maximum or minimum values no more than about once per second. After the gain of the amplifier 610 has been adjusted as such, the recording devices 110, 110′, 110″, can be used for the diagnostic uses noted above.
One way for performing such a calibration procedure is to install a recording device, such as any of the recording devices 110, 110′, 110″, with the amplifier 610 adjusted to its maximum gain value. This is because it is difficult to predict, as noted above, how strong the raw detected brainwave signals will be.
With the amplifier 610 adjusted to its maximum gain value, the patient can be released for an amount of time that will allow the patient to have several or more seizures. After such a time has expired, the patient can return so that a practitioner can read the information stored in the memory device 516 of the recording devices 110, 110′, 110″, to determine if the gain of the amplifier 610 was sufficiently high.
Reviewing the brainwave signals recorded by the recording devices 110, 110′, 110″, will reveal to a practitioner whether or not the gain of the amplifier 610 was sufficiently high. For example, practitioners can distinguish between brainwaves indicating normal brainwave activity and brainwaves indicating epileptic seizures. Thus, if the data recorded by the recording device 110 includes numerous and high frequency occurrences of the amplifier 610 reaching its saturation point during normal brainwave activity, the gain of the amplifier 610 was too high. As such, the practitioner can, using for example the control interface 518 (
When a seizure occurs, the EEG waveform typically appears as a reciprocating waveform that reaches saturation voltage for an extended period of time, for example, as shown in
Interictal (non-seizure) baseline EEG can also have brief periods of saturation that may be abnormal as shown in
For example, with reference to
As shown in
In some embodiments, the event detector 3300 can be programmed to determine whether saturation is occurring at a predetermined rate and/or for a predetermined sustained period of time. An exemplary waveform of significant neurological event is shown in
The waveform analyzer 514 can be configured to determine if any data point within any window is saturated. In the representative waveform in
In some embodiments, the practitioner can program the event detector 3300 with regard to how many windows within a continuous subset would need to have a saturated data point in order for the event detector to determine that a seizure has occurred. For example, the practitioner could specify that X out of Y contiguous windows would be required to have a saturated event (where Y is always greater or equal to X) for the event detector 3300 to determine a seizure or significant neurological event has occurred.
The table in
In some embodiments, the event detector 3300 can be configured to determine whether a seizure or other neurological event has occurred based upon analyses of X/Y saturation detections. In such embodiments, the event detector 3300 can be programmed to determine how frequently X/Y saturation detections are occurring and then only report neurological events to the practitioner if the X/Y saturation rate exceeds a certain rate of occurrence. For example, the detector 3300 can be configured to monitor the number of times that the X/Y saturation criteria were met in a programmable time window, but then only report an event to the practitioner if a minimum number of programmable X/Y saturation events were detected in a programmable time period.
For example, the detector 3300 can be programmed with a time window of 5 minutes and an X/Y saturation count criterion of 5. The detector would then only report a neurological event to the practitioner if 5 or more X/Y saturation events were to have occurred in the past 5 minutes.
The recording controller 3302 can be configured to record and store recordings of the patient's brainwaves under certain circumstances. In some embodiments, the recording controller 3302 can be configured to utilize the memory device 516 to serve as a linear cache and a file storage unit.
For example, in various other areas in the signal processing arts, a linear cache is a known device for storing a single stream of digital information in a proper sequence. As such, the linear cache maintains this stream as a list of the digital blocks that make up to stream. In some embodiments, the digital blocks can each have a unique size and unique attributes, or the blocks can have a predetermined size, for example corresponding to a predetermined period of time such as 1 second, 5 five seconds, 10 seconds, 30 seconds, etc. However, the blocks can have any size. Each block within the stream can be marked with a “presentation timestamp” which indicates when that block should be presented to a decoding process.
The presentation timestamp can be a monotonically increasing in value initialized at zero when the linear cache first begins operation on a stream of data. In some embodiments, the presentation timestamp generates its own time stamp signature without any relation to any other underlying clocking or streaming technique. The technique used for generating the presentation timestamp is also utilized by any decoding process used to read the digital blocks in the order recorded.
In some embodiments, the recording controller 3302 time stamps each encoded digital block of data from the sensing front end device 512 as it arrives at the recording controller 3302. In other words, the recording controller 3302 marks that block of data with the current presentation timestamp for the stream of data being recorded.
The recording controller 3302 can be configured to maintain a window of blocks in a window cache, for example. The recording controller 3302 can form a window cache of digital blocks, in the order according to the presentation timestamp values. As such, the window can contain the newest block that arrived in the window cache of digital blocks and the oldest block that this window cache is configured to hold. The window cache can be configured to hold any number of digital blocks.
For example, the window cache can be configured to hold the number of digital blocks corresponding to the amount of time to equal to 10 seconds, 30 seconds, 1 minute, 10 minutes, 30 minutes, 60 minutes, or any amount of time. In some embodiments, the recording controller 3302 can have an adjustable window size allowing a practitioner to adjust the duration of the window size which the window cache will hold. This allows the practitioner to adjust the length of the recorded brainwaves before a seizure is detected and after a seizure is detected.
In other words, the window cache of digital blocks represents a time span into the past history of the stream of brainwaves coming from the sensing front-end 512. The recording controller 3302 can be configured to discard digital blocks that fall outside the window cache. In other words, the recording controller 3302 can be configured to erase digital blocks that fall outside of the window cache. As such, the window is sized such that one can only look back a limited distance into the past history of the datastream output from the sensing front and 512. This allows for trade-offs between the available storage space and the availability of past information for storing.
Additionally, in some embodiments, the recording controller 3302 can be configured to store all or a portion of the digital blocks stored within the cache window into a file when the event detector 3300 indicates that a seizure or other event has occurred. In some embodiments, the recording controller 3302 can be configured to store all of the digital blocks held in the window cache in a file when the event detector 3300 indicates the seizure has begun or occurred and to continue to add digital blocks to the file for an amount of time after the event detector 3300 indicates the seizure has been detected. In some embodiments, the recording controller 3302 can be configured to continue recording the output from the sensing front and 512 until the event detector 3300 indicates that the seizure has ended. Further, in some embodiments, the recording controller 3300 can be configured to continue to add digital blocks to the file for a predetermined time after the event detector 3300 indicates that the seizure has ended.
Optionally, the recording controller 3302 can be configured to save only a number of digital blocks within the window, at the time detent detector 3300 indicates the seizure has begun, corresponding to a predetermined time before the event detector 3300 indicates the seizure has begun. This predetermined time can be any predetermined time. For example, but without limitation, this predetermined time can be equal to 10 seconds, 30 seconds, 60 seconds, or any predetermined amount of time. Additionally, in some embodiments, the recording controller 3302 can be configured to allow this predetermined time to be adjusted by a practitioner.
After the recording controller 3302 has collected all the digital blocks surrounding the detection of a seizure by the event detector 3300 and to include the digital blocks corresponding to the predetermined time periods before and after the event detector 3300 indicates a seizure has occurred, the recording controller 3302 can save the file including these blocks into the memory device 516. Additionally, the recording controller 3302 can stamp the file with the date and time for further analysis by a practitioner. As such, the waveform analyzer 514′ provides additional advantages in the ability to more simply distinguish between normal brain activity and brain activity associated with the seizure and to save the relevant portions of the brainwave signals received from the sensing front and 512 in a more efficient manner thereby saving memory and reducing power consumption.
The above described method for generating files of selected portions of detected brainwave activity can be incorporated into any of the other recording devices 110, 110′, 110″ described above or below.
Such a method for storing selected portions of detected brainwave activity can also aid in the process of calibrating the amplifier 610. For example, after the initial installation of a recording device, such as any of the recording devices 110, 110′, 110″, 110′″, and preferably after the patient has suffered one or more seizures, the files containing the selected portions of detective brainwave activity can be reviewed by a practitioner. An ordinary practitioner can readily identify whether or not these files of selected brainwave activity include brainwave activity resulting from a seizure.
If the practitioner determines that the files do not contain brainwaves resulting from seizure activity, the practitioner can use the recordings to determine what adjustments to make to the recording device 110. For example, the practitioner may determine that it is necessary to adjust the gain of the amplifier 610, or to make other adjustments.
In some embodiments, any of the recording devices 110, 110′, 110″, can include an alarm unit 3304 configured to provide a tactile stimulus to the patient in which the recording device is installed. For example, the alarm unit 3304 can include a speaker, vibrator, bone conduction speaker, or any other device that can provide a tactile stimulus to the patient. As such, this provides an additional advantage that the patient can be made aware that the recording device should be checked by practitioner.
For example, the power supply 432 (
However, the alarm unit 3304 can be used to communicate with the patient 112 for any reason. In an exemplary but nonlimiting embodiment, the alarm unit 3304 can emit audible beeps to the patient 112 if the recording device 110 should be checked by practitioner. For example, the alarm unit 3304 can be configured to emit 1 beep periodically to indicate that the patient 112 should contact their practitioner at their earliest convenience. Additionally, the alarm unit 3304 can be configured to emit two beeps periodically to indicate that the patient 112 should visit their practitioner as soon as possible. Other communication schemes can also be used.
An implantable version of a system according to some embodiments advantageously has a long-term average current consumption significantly less than 10 microamps, allowing the implanted device to operate on power provided by a coin cell or similarly small battery for a period of years without need for replacement. It should be noted, however, that as battery and power supply configurations vary, the long-term average current consumption of a device according to some embodiments may also vary and still provide satisfactory performance.
It should be observed that while the foregoing detailed description of various embodiments of the present inventions is set forth in some detail, the present inventions are not limited to those details and an implantable recording device 110 or neurological disorder detection device made according to the inventions can differ from the disclosed embodiments in numerous ways. In particular, it will be appreciated that embodiments of the present inventions may be employed in many different applications to detect anomalous neurological characteristics in at least one portion of a patient's brain. It will be appreciated that the functions disclosed herein as being performed by hardware and software, respectively, may be performed differently in an alternative embodiment. It should be further noted that functional distinctions are made above for purposes of explanation and clarity; structural distinctions in a system or method according to the inventions may not be drawn along the same boundaries. Hence, the appropriate scope hereof is deemed to be in accordance with the claims as set forth below.
| Patent | Priority | Assignee | Title |
| 11064926, | Jul 01 2011 | NeuroPace, Inc. | Systems and methods for assessing the effectiveness of a therapy including a drug regimen using an implantable medical device |
| 11071493, | Oct 24 2012 | Dreamscape Medical LLC | Multicomponent brain-based electromagnetic biosignal detection system |
| 11147978, | Oct 30 2019 | WYSS CENTER FOR BIO AND NEURO ENGINEERING | Feedthrough protective cover |
| ER9071, |
| Patent | Priority | Assignee | Title |
| 4566464, | Jul 27 1981 | DEVICE DEVELOPMENTS, INC | Implantable epilepsy monitor apparatus |
| 5857978, | Mar 20 1996 | Lockheed Martin Energy Systems, Inc. | Epileptic seizure prediction by non-linear methods |
| 5995868, | Jan 23 1996 | University of Kansas | System for the prediction, rapid detection, warning, prevention, or control of changes in activity states in the brain of a subject |
| 6006124, | May 01 1998 | NeuroPace, Inc | Means and method for the placement of brain electrodes |
| 6016449, | Oct 27 1997 | NEUROPACE | System for treatment of neurological disorders |
| 6018682, | Apr 30 1998 | Medtronic, Inc | Implantable seizure warning system |
| 6201980, | Oct 05 1998 | Lawrence Livermore National Security LLC | Implantable medical sensor system |
| 6466822, | Apr 05 2000 | NeuroPace, Inc | Multimodal neurostimulator and process of using it |
| 6473639, | Mar 02 2000 | NeuroPace, Inc | Neurological event detection procedure using processed display channel based algorithms and devices incorporating these procedures |
| 6594524, | Dec 12 2000 | TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA, THE | Adaptive method and apparatus for forecasting and controlling neurological disturbances under a multi-level control |
| 6647296, | Oct 27 1997 | NeuroPace, Inc. | Implantable apparatus for treating neurological disorders |
| 6726678, | Feb 22 2001 | REGENTS OF THE UNIVERSITY OF MINNEOSTA | Implantable reservoir and system for delivery of a therapeutic agent |
| 6810285, | Jun 28 2001 | NeuroPace, Inc.; NEUROPACE, INC , A CORP OF DELAWARE | Seizure sensing and detection using an implantable device |
| 7136695, | Oct 12 2001 | NeuroPace, Inc | Patient-specific template development for neurological event detection |
| 7174206, | Oct 15 2002 | Medtronic, Inc | Signal quality monitoring and control for a medical device system |
| 7177674, | Oct 12 2001 | NeuroPace, Inc | Patient-specific parameter selection for neurological event detection |
| 7277748, | Sep 13 2002 | NeuroPace, Inc | Spatiotemporal pattern recognition for neurological event detection and prediction in an implantable device |
| 20030004428, | |||
| 20030028229, | |||
| 20030074033, | |||
| 20030144711, | |||
| 20040054297, | |||
| 20040092801, | |||
| 20040133119, | |||
| 20040138518, | |||
| 20060111644, | |||
| 20060129056, | |||
| 20060287691, | |||
| 20070016094, | |||
| GB2406381, |
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